2014 - Ba - Readiness Quiz Final - Ga/Df

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  • 1/50 Questions

    What does OneExchange do as a company?

    • Largest private healthcare exchange in the nation.
    • Provide assistance to companies who are looking to improve retiree healthcare.
    • Provide a one-stop shop with meaningful choices.
    • All of the above.
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2014 - Ba - Readiness Quiz Final - Ga/Df - Quiz
About This Quiz

The 2014 BA Readiness Quiz Final for GA\/DF assesses knowledge on OneExchange operations, client-specific information handling, drug tier levels, and proper use of company resources. It ensures employees are proficient in customer service and compliant with healthcare standards.

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  • 2. 

    What function does Microsoft Outlook preform?

    • Timecard for pay

    • Instant message

    • Email

    • SSC time slots

    Correct Answer
    A. Email
    Explanation
    Microsoft Outlook is a software program that primarily functions as an email client. It allows users to send, receive, and manage their emails efficiently. Outlook also offers additional features such as organizing emails into folders, scheduling appointments and meetings, managing contacts, and integrating with other Microsoft Office applications. Therefore, the correct answer is "Email."

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  • 3. 

    When someone refers to a Medicare Part A, what does that relate to?

    • Prescription coverage

    • Medical Coverage

    • Hospital coverage

    • Special needs coverage

    Correct Answer
    A. Hospital coverage
    Explanation
    Medicare Part A refers to hospital coverage. This means that it covers inpatient care in hospitals, skilled nursing facilities, and hospice care. It also includes limited coverage for home health care services. Medicare Part A is one of the four parts of the Medicare program, which provides health insurance for individuals who are 65 years old or older, as well as certain younger individuals with disabilities.

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  • 4. 

    Where is the Rx Profiler located?

    • ADP

    • SSC

    • Empower

    • Microsoft Office

    Correct Answer
    A. SSC
    Explanation
    The Rx Profiler is located in SSC.

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  • 5. 

    Which section is not found in the client guide?

    • Mailers

    • Funding

    • Enrollment

    • Available plans

    Correct Answer
    A. Available plans
    Explanation
    The section that is not found in the client guide is "Available plans". This means that the client guide does not provide information or details about the different plans that are available. The guide may include information about mailers, funding, and enrollment, but it does not cover the available plans.

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  • 6. 

    What step would you take if a drug is identified as non-covered?

    • Re-verify the drug with the customer

    • Check for the correct spelling of the drug

    • Check drug on Medicare.gov

    • All of the above

    Correct Answer
    A. All of the above
    Explanation
    If a drug is identified as non-covered, the best step to take would be to re-verify the drug with the customer to ensure accuracy. Additionally, checking for the correct spelling of the drug is important to avoid any confusion or errors. Lastly, checking the drug on Medicare.gov can provide further information on coverage and eligibility. Therefore, all of the above steps are necessary to address the issue of a non-covered drug.

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  • 7. 

    After it is pinned to the taskbar, the icon EH is a quick way to open what program?

    • ADP

    • SSC

    • Empower

    • Extend Health Information Center

    Correct Answer
    A. SSC
    Explanation
    The correct answer is SSC. After pinning the icon EH to the taskbar, it provides a quick way to open the SSC program.

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  • 8. 

    You have received an email that has multiple people involved. Your supervisor sent it to you to answer a question he has. Which method would you use to answer his comments directly to him?

    • Forward

    • Follow up

    • Reply all

    • Reply

    Correct Answer
    A. Reply
    Explanation
    To answer the supervisor's question directly, the most appropriate method would be to use the "Reply" option. This allows you to respond directly to the sender without involving all the other recipients of the email. Using "Reply all" would include everyone in the email thread, which may not be necessary if the question is specific to the supervisor. Forwarding the email would pass the responsibility to someone else, and following up may not directly address the supervisor's question.

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  • 9. 

    When verifying the Medicare claim number, advise the retiree it is their Social Security number with a letter at the end.

    • True

    • False

    Correct Answer
    A. False
    Explanation
    The explanation for the correct answer, False, is that when verifying the Medicare claim number, it is not advised to tell the retiree that their Medicare claim number is their Social Security number with a letter at the end. This is because sharing personal information like the Social Security number can pose a risk to the retiree's privacy and security. It is important to handle personal information with care and follow proper protocols for verifying and protecting sensitive data.

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  • 10. 

    Medicare Part A and B effective dates are always the same dates.

    • True

    • False

    Correct Answer
    A. False
    Explanation
    The statement is false because Medicare Part A and B effective dates can be different. Medicare Part A is usually effective from the first day of the month an individual turns 65 or becomes eligible due to a disability, while Medicare Part B can have a different effective date depending on when the individual enrolls. Therefore, the effective dates for Medicare Part A and B are not always the same.

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  • 11. 

    No special consideration is needed on selecting a plan for someone who is in a nursing home?

    • True

    • False

    Correct Answer
    A. False
    Explanation
    Special consideration is needed when selecting a plan for someone who is in a nursing home. Nursing home residents often have specific healthcare needs that require personalized care and attention. Factors such as medication management, specialized therapies, and assistance with daily activities need to be taken into account when choosing a suitable plan for them. Therefore, it is false to say that no special consideration is needed in this situation.

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  • 12. 

    The Annual Election Period is a time when a customer can change a CMS plan. In what time period can this be accomplished? 

    • Aug 15 to Oct 1

    • Oct 1 to Dec 7

    • Oct 15 to Dec 7

    • Jan 1 to Feb 14

    Correct Answer
    A. Oct 15 to Dec 7
    Explanation
    During the time period from October 15 to December 7, customers are able to change a CMS plan. This period is known as the Annual Election Period, which allows customers to make changes to their plan, such as switching to a different CMS plan or enrolling in a new plan altogether. This time frame is specifically designated for customers to review their options and make any necessary changes to their healthcare coverage.

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  • 13. 

    HMO’s require a primary care physician number.

    • True

    • False

    Correct Answer
    A. True
    Explanation
    HMOs, or Health Maintenance Organizations, typically require their members to have a primary care physician (PCP) number. This means that individuals enrolled in an HMO must choose a primary care doctor who will serve as their main point of contact for all their healthcare needs. The PCP will coordinate and manage their overall healthcare, including referrals to specialists and ordering necessary tests or treatments. This requirement helps ensure that healthcare is coordinated and that individuals receive appropriate and timely care. Therefore, the statement "HMOs require a primary care physician number" is true.

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  • 14. 

    The Client Guide details information we use to research the following:

    • Networks for doctors and hospitals

    • Plans that are offered according to zip codes

    • Specifics that relate to a customer’s current or former employer

    • Explaining deductibles

    Correct Answer
    A. Specifics that relate to a customer’s current or former employer
    Explanation
    The Client Guide provides information about a customer's current or former employer. This information is used to research networks for doctors and hospitals, plans offered according to zip codes, and to explain deductibles. The guide contains specific details that are relevant to the customer's employer, such as the coverage options available, network providers associated with the employer, and any unique benefits or discounts offered through the employer. This information helps the customer make informed decisions about their healthcare options based on their current or previous employment.

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  • 15. 

    Which of the following descriptions would best describe a drug restriction?

    • Cost

    • Tier level

    • Non-network Pharmacy

    • Step therapy

    Correct Answer
    A. Step therapy
    Explanation
    Step therapy is a type of drug restriction where patients are required to try less expensive or alternative medications before they can access more expensive or advanced treatments. This approach is commonly used by insurance companies to control costs and ensure that patients receive the most appropriate and cost-effective treatment for their condition. By implementing step therapy, insurance providers can encourage the use of lower-cost drugs and reserve more expensive options for cases where they are truly necessary.

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  • 16. 

    It is required that a retiree attend a retiree meeting prior to enrolling in plans with OneExchange.

    • True

    • False

    Correct Answer
    A. False
    Explanation
    Retirees are not required to attend a retiree meeting prior to enrolling in plans with OneExchange.

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  • 17. 

    Which of the following would be identified as a deductible for a PDP?

    • A standard amount you pay based on a tier level

    • A fixed amount that must be paid before the plan pays

    • A percentage of the cost that must be paid to the pharmacy

    • Deductibles for PDP are not required

    Correct Answer
    A. A fixed amount that must be paid before the plan pays
    Explanation
    A deductible for a PDP refers to a fixed amount that an individual must pay out of pocket before their insurance plan starts covering the costs. This amount is predetermined and does not change based on tier levels or percentages of the cost. Therefore, the correct answer is "A fixed amount that must be paid before the plan pays."

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  • 18. 

    Most customers want to get the most coverage at a price they can afford. In this case, you should choose a gap plan because the customer does not have to pay the Part B premium with a gap plan. 

    • True

    • False

    Correct Answer
    A. False
    Explanation
    The explanation for the given correct answer (False) is that the statement is incorrect. A gap plan does not exempt the customer from paying the Part B premium. Therefore, choosing a gap plan does not eliminate the need to pay the premium, and the statement is false.

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  • 19. 

    The carrier guide can you help with all but what?

    • Find a doctor

    • Find a hospital

    • Find Value added benefits

    • Find quotable Premium

    Correct Answer
    A. Find quotable Premium
    Explanation
    The carrier guide can help with finding a doctor, finding a hospital, and finding value-added benefits. However, it cannot help with finding quotable premiums. This means that the carrier guide does not provide information or assistance in obtaining insurance premium quotes.

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  • 20. 

    Which tab isn’t found under work resources?

    • Call guides

    • Speed sheets

    • Medicare costs

    • State guide

    Correct Answer
    A. Medicare costs
    Explanation
    The tab "Medicare costs" is not found under work resources. This implies that the other three tabs, namely "Call guides," "Speed sheets," and "State guide," are found under work resources.

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  • 21. 

    Part A covers physician services.

    • True

    • False

    Correct Answer
    A. False
    Explanation
    Part A does not cover physician services. Physician services are covered under Part B of Medicare. Part A mainly covers hospital stays, skilled nursing facility care, and some home health care services.

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  • 22. 

    A HMO has a distinct requirement that some of the other Medicare Advantage plans do not have. Which of the following represents that requirement?   

    • Can use any doctor or hospital

    • Has networks

    • Always has prescription plans included

    • Can be used anywhere in the country

    Correct Answer
    A. Has networks
    Explanation
    A Health Maintenance Organization (HMO) has a distinct requirement that some other Medicare Advantage plans do not have, which is the presence of networks. Networks consist of a specific group of doctors, hospitals, and other healthcare providers that have agreed to provide services to the members of the HMO. This means that HMO members can only receive covered healthcare services from providers within the network, and out-of-network services may not be covered or may have higher costs. Therefore, the correct answer is "Has networks."

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  • 23. 

    When securing the call with the retiree, which pieces of information must be obtained in order to be compliant?  Choose all correct answers.

    • Phone number

    • Gender

    • Last 4 digits of SS number

    • Date of birth

    Correct Answer(s)
    A. Phone number
    A. Last 4 digits of SS number
    A. Date of birth
    Explanation
    To be compliant when securing the call with the retiree, the phone number, last 4 digits of the SS number, and date of birth must be obtained. This information helps to verify the identity of the retiree and ensure that the call is being conducted with the correct person. Gender is not necessary for compliance purposes in this scenario.

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  • 24. 

    Which pharmacy would you expect to get a lower cost for covered drugs? 

    • Network Pharmacy

    • Long Term Care Pharmacy

    • Preferred Network Pharmacy

    • There is no difference in costs on Medicare PDP's

    Correct Answer
    A. Preferred Network Pharmacy
    Explanation
    Preferred Network Pharmacies typically have lower costs for covered drugs compared to other types of pharmacies. This is because they have negotiated lower prices with the insurance plans and offer discounted rates to plan members. Long Term Care Pharmacies, on the other hand, specialize in providing medications to residents of long-term care facilities and may not have the same cost-saving agreements in place. Network Pharmacies may or may not offer discounted rates, depending on their agreements with the insurance plans. The statement "There is no difference in costs on Medicare PDP's" is incorrect as there can be variations in costs depending on the type of pharmacy.

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  • 25. 

    Selecting a pharmacy in the Rx Profiler prior to searching plans will save the BA time in determining whether the customer’s pharmacy is a preferred or network pharmacy?

    • True

    • False

    Correct Answer
    A. True
    Explanation
    Selecting a pharmacy in the Rx Profiler prior to searching plans will save the BA time in determining whether the customer's pharmacy is a preferred or network pharmacy. This is because by selecting a pharmacy beforehand, the BA can filter the plans based on the preferred or network pharmacies associated with that specific pharmacy. This eliminates the need for the BA to manually check each plan to determine if the customer's pharmacy is included in the network, saving time and effort.

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  • 26. 

    Part B is also known as Medical insurance.

    • True

    • False

    Correct Answer
    A. True
    Explanation
    Part B is also known as Medical insurance. This statement is true. Part B refers to the medical insurance coverage provided by Medicare. It helps cover medically necessary services such as doctor's visits, outpatient care, preventive services, and durable medical equipment. Part B is one of the two main parts of Original Medicare, the other being Part A which covers hospital insurance.

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  • 27. 

    Explaining the HRA is important on your calls because

    • It pays for all the retirees expenses

    • It always keeps them from paying out of pocket

    • It helps subsidize their new premiums

    • You can tell them they won’t ever have to pay anything up front

    Correct Answer
    A. It helps subsidize their new premiums
    Explanation
    The correct answer is "It helps subsidize their new premiums". This explanation is important because it highlights the role of HRA in assisting retirees with their new premiums. By subsidizing their premiums, the HRA helps reduce the financial burden on retirees and ensures that they do not have to pay the full amount out of pocket. This information is crucial to communicate to retirees during calls as it helps them understand the financial support they can expect from the HRA.

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  • 28. 

    The Medicare Initial Coverage Election Period is how long?

    • 3 months

    • 5 months

    • 7 months

    • 9 months

    Correct Answer
    A. 7 months
    Explanation
    The Medicare Initial Coverage Election Period is 7 months long. This period allows individuals who are newly eligible for Medicare to enroll in a Medicare Advantage or Medicare Prescription Drug Plan. It starts three months before the month of their 65th birthday and ends three months after the month of their 65th birthday. This gives individuals a total of 7 months to make their initial coverage election.

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  • 29. 

    On a call with a customer, the fastest way to the client guide is through the SSC?

    • True

    • False

    Correct Answer
    A. True
    Explanation
    The statement suggests that the fastest way to access the client guide during a call with a customer is through the SSC (presumably meaning the Service Support Center or a similar system). This implies that the SSC provides quick and easy access to the necessary information or resources needed to assist the customer. Therefore, the correct answer is True.

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  • 30. 

    If you travel and need a Medicare Advantage Plan that offers coverage outside of the network, which plan would you choose?

    • GAP

    • HMO

    • PPO

    • PDP

    Correct Answer
    A. PPO
    Explanation
    If you travel and need a Medicare Advantage Plan that offers coverage outside of the network, the plan you would choose is a PPO (Preferred Provider Organization). PPO plans allow you to receive healthcare services from both in-network and out-of-network providers. This means that even if you are traveling and need medical attention, you can still receive coverage and benefits from your PPO plan.

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  • 31. 

    OTC (over the counter) drugs are important to the health of a customer. It is important to collect this information so the customer will have a fair comparison of their total monthly drug cost.

    • True

    • False

    Correct Answer
    A. False
    Explanation
    The statement suggests that collecting information about OTC drugs is important for customers to have a fair comparison of their total monthly drug cost. However, OTC drugs are typically not covered by insurance plans and are purchased directly by the customer without a prescription. Therefore, including the cost of OTC drugs in the comparison of total monthly drug cost would not be relevant or accurate. Hence, the answer is false.

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  • 32. 

    If a customer wanted a Medigap Plan that had a network, what type of plan would they choose?

    • Standard

    • High Deductible

    • Plan F

    • Select

    Correct Answer
    A. Select
    Explanation
    If a customer wanted a Medigap Plan that had a network, they would choose the "Select" plan. The Select plan is a type of Medigap plan that requires beneficiaries to use a network of healthcare providers in order to receive full coverage. This means that if the customer goes outside of the network, they may have to pay higher out-of-pocket costs. Therefore, the Select plan is the best option for someone who wants a Medigap plan with a network.

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  • 33. 

    Medigaps are always your first options when selling a plan?

    • True

    • False

    Correct Answer
    A. False
    Explanation
    The statement is incorrect. Medigap plans are not always the first option when selling a plan. Medigap plans, also known as Medicare Supplement plans, are additional insurance policies that can be purchased to cover the gaps in Original Medicare. However, there are other options available such as Medicare Advantage plans, which provide an alternative way to receive Medicare benefits. Therefore, Medigap plans are not always the first choice when selling a plan.

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  • 34. 

    When linking or adding a member to an existing account, which method would you choose to ensure the step is completed correctly?

    • Contact ADP

    • Transfer to CSR

    • Ask Infosource

    • Complete the task yourself

    Correct Answer
    A. Ask Infosource
    Explanation
    To ensure that the step of linking or adding a member to an existing account is completed correctly, it would be best to ask Infosource for assistance. Infosource is likely to have the necessary information and resources to guide and support in completing the task accurately. Contacting ADP may not provide the specific guidance needed for this task, transferring to a CSR may not guarantee the right expertise, and completing the task oneself may lead to errors or lack of knowledge. Therefore, asking Infosource would be the most reliable option.

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  • 35. 

    A non-preferred generic drug is identified as which tier level in most plans?

    • Tier 1

    • Tier 2

    • Tier 3

    • Tier 4

    Correct Answer
    A. Tier 2
    Explanation
    A non-preferred generic drug is identified as Tier 2 in most plans. This means that it is not the first choice for a generic drug and may have a slightly higher copayment or coinsurance compared to Tier 1 drugs, which are the preferred generics. Tier 3 and Tier 4 drugs are typically brand-name drugs or specialty drugs, which are usually more expensive and have higher copayments or coinsurance.

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  • 36. 

    Prescription drug plans do not require a deductible to be paid for mail order.

    • True

    • False

    Correct Answer
    A. False
    Explanation
    Prescription drug plans do require a deductible to be paid for mail order. This means that individuals must pay a certain amount out of pocket before their insurance coverage kicks in for mail order prescriptions. Therefore, the statement that prescription drug plans do not require a deductible for mail order is incorrect.

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  • 37. 

    A customer may change his CMS plan into a CMS Five-Star plan only one time per CMS calendar year.

    • True

    • False

    Correct Answer
    A. True
    Explanation
    The statement suggests that a customer has the option to change their CMS plan into a CMS Five-Star plan, but they can only do so once per CMS calendar year. This means that if a customer decides to switch to a CMS Five-Star plan, they need to carefully consider their decision as they will not be able to change their plan again until the next CMS calendar year. Therefore, the answer "True" indicates that the statement is correct.

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  • 38. 

    What do you do as a BA?  Choose all correct answers.

    • You are a licensed guide.

    • You provide biased recommendations to certain carriers in order to increase your sales commissions.

    • You make plan recommendations as quickly as possible in order to answer as many calls as you can.

    • Your position is to make this transition easy and simple for our customers

    Correct Answer(s)
    A. You are a licensed guide.
    A. Your position is to make this transition easy and simple for our customers
    Explanation
    The correct answers for this question are "You are a licensed guide" and "Your position is to make this transition easy and simple for our customers." These answers align with the role of a Business Analyst (BA) who assists in guiding and facilitating the transition process for customers, ensuring it is smooth and uncomplicated. The other options provided, such as providing biased recommendations or focusing on answering as many calls as possible, do not accurately describe the responsibilities of a BA.

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  • 39. 

    Certain drugs are covered in some plans but not others. A customer demands to know why his drug is not covered. Which of the following would you tell the customer?

    • Some carriers cannot afford to cover the drug

    • Some carriers do not want the risk of providing the drug

    • The drug is not listed in the formulary

    • All of the above

    Correct Answer
    A. The drug is not listed in the formulary
    Explanation
    The customer's drug is not covered because it is not listed in the formulary. This means that the drug is not included in the list of medications covered by the insurance plan. It is possible that the drug is not included in the formulary due to various reasons such as cost, risk factors, or other considerations.

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  • 40. 

    When searching for a record in the SSC, is the statement “enter the least amount of information to obtain the largest amount of records” correct?

    • True

    • False

    Correct Answer
    A. True
    Explanation
    The statement "enter the least amount of information to obtain the largest amount of records" is correct when searching for a record in the SSC. This means that by providing minimal information, the search will yield a larger number of results. This can be useful when trying to gather a broad range of records or when unsure about the specific details of the record being searched for.

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  • 41. 

    What is the correct way to turn off your computer at the end of the shift?

    • Lock the computer

    • Restart and lock the computer

    • Log off

    • Unplug the computer and monitor

    Correct Answer
    A. Log off
    Explanation
    Logging off is the correct way to turn off your computer at the end of the shift. When you log off, you are closing all your open applications and ending your session, allowing the computer to be used by someone else. This ensures that your work is saved and any personal information is protected. Restarting and locking the computer may not be necessary unless there are specific instructions to do so. Unplugging the computer and monitor is not recommended as it can cause data loss and potential damage to the hardware.

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  • 42. 

    A non-preferred brand drug is identified as which tier level in most plans?

    • Tier 1

    • Tier 2

    • Tier 3

    • Tier 4

    Correct Answer
    A. Tier 4
    Explanation
    A non-preferred brand drug is identified as Tier 4 in most plans. This means that it is the highest tier level and usually comes with the highest cost-sharing for the insured individual. Tier 4 drugs are typically more expensive and may have cheaper alternatives available in lower tiers.

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  • 43. 

    Retirees must receive and complete the Getting Started Guide and the Enrollment Guide prior to enrolling in plans with One Exchange.

    • True

    • False

    Correct Answer
    A. False
    Explanation
    Retirees are not required to receive and complete the Getting Started Guide and the Enrollment Guide prior to enrolling in plans with One Exchange.

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  • 44. 

    If a customer moves into or resides in a nursing home they have a SEP to change a Medicare Advantage or PDP. When can they enroll into a different CMS plan?

    • Any time after moving into

    • 2 months before moving into

    • 1 month before moving into

    • 15 days before moving into

    Correct Answer
    A. Any time after moving into
    Explanation
    When a customer moves into or resides in a nursing home, they are granted a Special Enrollment Period (SEP) to change their Medicare Advantage or Prescription Drug Plan (PDP). This means that they have the flexibility to enroll in a different CMS plan at any time after moving into the nursing home. This allows them to make changes to their healthcare coverage based on their new living situation and healthcare needs.

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  • 45. 

    If a customer suffers a loss of group coverage, how many months will he have to enroll after the effective date for the loss of coverage?

    • 6 months

    • 2 months

    • 3 months

    • 1 month

    Correct Answer
    A. 2 months
    Explanation
    If a customer suffers a loss of group coverage, he will have 2 months to enroll after the effective date for the loss of coverage. This means that the customer has a two-month window to enroll in a new coverage plan after experiencing a loss of group coverage.

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  • 46. 

    BA’s are required to read the Medical Information Release (MIR) statement every time they talk with a retiree prior to asking Situation Analysis and prescription questions.

    • True

    • False

    Correct Answer
    A. False
    Explanation
    BA's are not required to read the Medical Information Release (MIR) statement every time they talk with a retiree prior to asking Situation Analysis and prescription questions.

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  • 47. 

    You can always find the Clients contact number in the client guide?

    • True

    • False

    Correct Answer
    A. False
    Explanation
    The statement suggests that the client's contact number can always be found in the client guide. However, the correct answer is false. This implies that the client's contact number may not always be available in the client guide.

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  • 48. 

    If a customer is outside the service area for 6 months without notifying the carrier or Social Security, the carrier will cancel the plan. How many months does the customer have to enroll into a new plan? 

    • Cannot enroll

    • 2 months

    • 3 months

    • 1 month

    Correct Answer
    A. 3 months
    Explanation
    If a customer is outside the service area for 6 months without notifying the carrier or Social Security, the carrier will cancel the plan. The customer will then have 3 months to enroll into a new plan. This means that after the cancellation of the previous plan, the customer has a window of 3 months to select and enroll in a new plan before they are left without coverage.

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  • 49. 

    If a customer notifies a carrier or Social Security of a permanent move outside the plan’s service area, how many months does he have to enroll into a different plan?

    • 2 months

    • 3 months

    • 4 months

    • 6 months

    Correct Answer
    A. 4 months
    Explanation
    If a customer notifies a carrier or Social Security of a permanent move outside the plan's service area, they have 4 months to enroll into a different plan. This allows the customer enough time to make the necessary arrangements and find a new plan that will cover their healthcare needs in the new location.

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Quiz Review Timeline (Updated): Mar 20, 2023 +

Our quizzes are rigorously reviewed, monitored and continuously updated by our expert board to maintain accuracy, relevance, and timeliness.

  • Current Version
  • Mar 20, 2023
    Quiz Edited by
    ProProfs Editorial Team
  • Jun 19, 2014
    Quiz Created by
    Bthorup
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